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PrEP Implications for Thailand
Global Perspectives on PrEP: Implications for Thailand

Released: November 12, 2025

Jakkrapatara Boonruang
Jakkrapatara Boonruang, MD
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Key Takeaways
  • Numerous studies at the 20th European AIDS Conference demonstrate that long-acting PrEP could help to facilitate HIV prevention for people who struggle with adherence challenges to daily oral PrEP.
  • Other studies demonstrate that meaningful engagement with underserved communities can positively influence social determinants of health, enhance HIV prevention, and improve overall well-being.

The 20th European AIDS Conference showcased cutting-edge innovations in HIV pre-exposure prophylaxis (PrEP) delivery and management, from data on long-acting innovations to person-centered service models, offering valuable insights for healthcare professionals and people living with HIV globally.

Thailand, a regional leader in community-driven HIV services, stands to benefit in particular from these advancements, which could further expand access to PrEP, enhance adherence, and promote equity in HIV prevention. 

Expansion of PrEP Beyond Key Populations
The 20th EACS emphasized the importance of engaging communities broadly and meaningfully in HIV prevention efforts. Although key populations continue to be prioritized, several countries are exploring strategies to expand PrEP access to the broader population.

High rates of PrEP discontinuation among cisgender women in France suggest that current PrEP options may not adequately meet their needs. Long-acting PrEP innovations could potentially help to address this gap. Such innovations are not only relevant for cisgender women, but they also hold promise for men who have sex with men and trans and gender-diverse individuals:

  • A discrete choice experiment in Canada reported an overall increase in PrEP uptake among men who have sex with men when more options were available, whereas a cross-sectional survey in 20 European countries revealed high interest and intention to use long-acting (LA) PrEP among transgender populations.
  • Moreover, an online survey in Belgium found that men who have sex with men who had previously discontinued PrEP or reported suboptimal use expressed greater intention to resume LA PrEP.
  • Studies conducted in Italy demonstrated a high acceptability and tolerability of LA cabotegravir injection among men who have sex with men, with many of them reporting previous suboptimal oral PrEP use.
  • Furthermore, results from the PURPOSE 2 trial—which demonstrated superior efficacy of twice-yearly lenacapavir subcutaneous injections compared with daily oral tenofovir disoproxil fumarate/emtricitabine among gay, bisexual, and transgender individuals—also revealed higher annual persistence with injections than with oral PrEP.

This evidence collectively suggests that LA PrEP products are a game-changer in HIV prevention by appealing to broader populations and effectively serving the needs of those who face challenges with oral PrEP.

Community Engagement for HIV Prevention and Beyond
Several oral presentations also explored how meaningful engagement with underserved communities can effectively influence their social determinants of health, enhance HIV prevention, and improve their overall well-being. A notable example is the Jasmine Project, which addresses sexual violence among female sex workers, thereby preventing numerous assaults and linking survivors to postexposure prophylaxis, effectively reducing HIV risk.

Similarly, community-based HIV and viral hepatitis screening campaigns among migrant populations in Spain emphasized the crucial role of community involvement in HIV responses, effectively identifying undiagnosed cases among underserved groups.

The Path Forward for Thailand
As HIV prevention and treatment enter the era of LA technologies with LA cabotegravir and lenacapavir, Thailand must remain resilient and prepared for their introduction. Evidence presented at EACS emphasized the potential of LA PrEP to increase uptake and reduce barriers across diverse populations—provided these innovations remain accessible to those who need them.

This presents a particular challenge in Thailand, which has successfully demedicalized PrEP through key population-led services, allowing lay providers to prescribe PrEP with physician teleconsultation. The introduction of LA PrEP risks remedicalizing PrEP delivery, restricting PrEP access within hospital settings. It is, therefore, essential to initiate discussions among all stakeholders, especially with communities, to identify effective implementation strategies and ensure a successful rollout. 

Furthermore, EACS underscored the critical role of community-led responses in addressing intersectional challenges among underserved populations. Thailand, with its strong community engagement, has the infrastructure to strengthen community capacity. With adequate domestic funding to replace previous international support, Thailand could emerge as a regional leader in community-led HIV responses and advancement toward ending AIDS by 2030.

Your Thoughts
What challenges do you foresee with the expansion of LA PrEP? What type of community-led or government-led support do you feel would be most helpful for implementation of LA PrEP? Leave a comment to join the discussion!

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